Malaria in Nigeria: a revisit

Salako, L.A.; Ajayi, Funmilayo O.; Sowunmi, A.; Walker, O

doi:10.1080/00034983.1990.11812493

Cited by 112 publications

(87 citation statements)

References 11 publications

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“…"Tncomplicated hyperparasitaemia is not uncommon in African children presenting with acute, symptomatic, falciparum malaria (Salako et al, 1990;Sowunmi el al., 1992Sowunmi el al., , 1996Sowunmi el al., , 2000. Prevalence rates in endemic and non endemic areas in Africa probably vary widely; in southwest Nigeria, the rate is approximately 10-12 % (Sowunmi.…”

Section: Discussionmentioning

confidence: 99%

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Plasmodium falciparumhyperparasitaemia in children

et al. 2004

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Summary:The risk factors associated with hyperparasitemia at presentation and after treatment with different antimalarial drug regimens were evaluated in f ,048 children enrolled prospectively in seven antimalarial drug trials between July 1996 and September 2003 in a hyperendemic area of southwestern Nigeria. The outcomes of treatment of hyperparasitaemia, and gametocyte carriage following treatment were also evaluated. The children were assigned to one of seven treatment groups : chloroquine (CQ) only ; pyrimethamine-sulfadoxine (PS] only; amodiaquine (AQ) only; CQ plus chlorpheniramine (CQCP); PS combined with CQ or AQ (COM°); PS combined with probenecid (PPS); and halofantrine (HF|. Hyperparasitaemia was found in 100 (9,5 %] of the 1,048 children at enrolment (day 0). Following oral therapy, 1.2 % of all patients (i.e. 1 3 patients) became hypeparasitaemic, which developed in all patients by day 1 of follow-up. In a multiple regression model, age < 5 years, and a core temperature (oral or rectal) > 39.5°C were found to be independent risk factors for hyperparasitaemia at enrolment. Following therapy, the cure rate on day 1 4 was significantly lower in those treated with CQ compared to other treatment groups. Severe resistance (RIII) response to treatment occurred significantly more frequently in those with hyperparasitaemia at enrolment than in those without, and was seen in five and one child with hyperparasitaemia who were treated with CQ and CQCP, respectively. Gametocyte carriage was insignificantly lower at enrolment and at all times following treatment in children with hyperparasitaemia than in ageand gender-matched children without hyperparasitaemia who received the same treatment. The results are discussed in the light of management of uncomplicated hyperparasitaemia in children in endemic settings. KEY WORDS

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Section: Discussionmentioning

confidence: 99%

“…T he study took place between July 1996 and September 2003 in patients presenting at the University College Hospital in Ibadan, a hyperendemic area for malaria in southwestern Nigeria (Salako et al, 1990). Ethical clearance was provided by the local ethics committee.…”

Section: Patientsmentioning

confidence: 99%

Plasmodium falciparumhyperparasitaemia in children

et al. 2004

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“…Patients enrolled in drug studies -Patients were recruited into antimalarial efficacy studies as described previously (Sowunmi et al 2009a), from January 2001-November 2010, at The Malaria Clinic of the University College Hospital in Ibadan, a malaria-endemic area in southwest Nigeria (Salako et al 1990). All patients with a presumptive diagnosis of malaria were evaluated for the presence of P. falciparum parasitaemia.…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

Plasmodium falciparum gametocyte carriage, sex ratios and asexual parasite rates in Nigerian children before and after a treatment protocol policy change instituting the use of artemisinin-based combination therapies

Gbotosho

Sowunmi

Happi

et al. 2011

Mem. Inst. Oswaldo Cruz

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The effects of artemisinin-based combination therapies (ACTs) on transmission of Plasmodium falciparum were evaluated after a policy change instituting the use of ACTs in an endemic area. P. falciparum gametocyte carriage, sex ratios and inbreeding rates were examined in 2,585 children at presentation with acute falciparum malaria during a 10-year period from 2001-2010. Asexual parasite rates were also evaluated from 2003-2010 in 10,615 children before and after the policy change. Gametocyte carriage declined significantly from 12.4% in 2001 to 3.6% in 2010 (@@χ2 for trend = 44.3, p < 0.0001), but sex ratios and inbreeding rates remained unchanged. Additionally, overall parasite rates remained unchanged before and after the policy change (47.2% vs. 45.4%), but these rates declined significantly from 2003-2010 (@@χ2 for trend 35.4, p < 0.0001). Chloroquine (CQ) and artemether-lumefantrine (AL) were used as prototype drugs before and after the policy change, respectively. AL significantly shortened the duration of male gametocyte carriage in individual patients after treatment began compared with CQ (log rank statistic = 7.92, p = 0.005). ACTs reduced the rate of gametocyte carriage in children with acute falciparum infections at presentation and shortened the duration of male gametocyte carriage after treatment. However, parasite population sex ratios, inbreeding rates and overall parasite rate were unaffected

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“…Our finding that a significantly larger number of patients receiving proguanil than pyrimethamine and placebo had splenomegaly may have accounted for the hemolytic crises, although malarial infection without splenomegaly may cause hemolysis in patients with or without SCD. 27 This finding may mean that proguanil is contraindicated in tropical splenomegaly syndrome, a clinical condition associated with massive splenomegaly in areas where malaria is endemic. 24 It is likely that blood transfusion did not have a significant impact on the results of our study.…”

Section: Discussionmentioning

confidence: 99%

Effects of pyrimethamine versus proguanil in malarial chemoprophylaxis in children with sickle cell disease: a randomized, placebo-controlled, open-label study

Eke

Anochie

2003

Current Therapeutic Research

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Background: Malarial chemoprophylaxis is essential for patients with homozygous sickle cell disease (SCD) who live in areas where malaria is endemic. Endemic regions include most sub-Saharan African countries and Southeast Asia.Objective: This study compared the efficacy and tolerability of pyrimethamine with that of proguanil and placebo in the prevention of malaria and the complications of Plasmodium falciparum infection (hepatomegaly, splenomegaly, bone pain crisis, hemolytic crisis) in children with SCD.Methods: In this single-center, open-label study conducted in Nigeria, children aged 1 to 16 years with SCD were randomly assigned to receive tablets of pyrimethamine (0.5 mg/kg·wk), proguanil (1.5 mg/kg·d), or placebo (vitamin C, 7 mg/kg·d) for 9 months as prophylaxis from February to December (which includes the rainy season), the period of greatest malarial transmission. The clinical and laboratory features of malaria (presence of parasitemia, parasite count and density, hepatomegaly and/or splenomegaly, symptomatic malarial infection [fever, rigors], bone pain crises, and hemolytic crises) were assessed.Results 9.5 [3.7] years; range, 3-16 years); and the placebo group, 29 patients (mean age, 5.9 years; range, 1-14 years). The male:female ratio was 1.1:1 in the pyrimethamine group, 1:1.7 in the proguanil group, and 1.6:1 in the placebo group. Parasitemia was noted in 7 patients (19.4%) in the pyrimethamine group, 6 (18.8%) in the proguanil group, and 7 (24.1%) in the placebo group at the start of the study. P falciparum was the only isolate.Accepted for publication August 6, 2003. doi:10.1016/S0011-393X(03)00161-9 Reproduction in whole or part is not permitted.0011-393X/03/$19.00 616Copyright ą 2003 Excerpta Medica, Inc. F.U. Eke and I. AnochieThe mean parasite density over the 9-month period was significantly lower with proguanil compared with pyrimethamine (P ϭ 0.045) and placebo (P Ͻ 0.05). The incidence of splenomegaly was least with pyrimethamine, but this group had the most patients clinically diagnosed with malaria. Hospitalizations and episodes of bone pain and hemolytic crisis occurred most frequently with placebo. One patient in the placebo group died of septicemia. Conclusions: Proguanil and pyrimethamine both reduced parasitemia; however, proguanil significantly decreased mean parasite density more effectively than pyrimethamine. Pyrimethamine and proguanil may protect children with SCD from the complications of P falciparum infection despite persistent parasitemia. Proguanil may be more useful than pyrimethamine in the prevention of bone pain crises among patients with SCD. (Curr Ther Res Clin Exp. 2003; 64:616-625)

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Malaria in Nigeria: a revisit

Cited by 112 publications

References 11 publications

Plasmodium falciparumhyperparasitaemia in children

Plasmodium falciparumhyperparasitaemia in children

Plasmodium falciparum gametocyte carriage, sex ratios and asexual parasite rates in Nigerian children before and after a treatment protocol policy change instituting the use of artemisinin-based combination therapies

Effects of pyrimethamine versus proguanil in malarial chemoprophylaxis in children with sickle cell disease: a randomized, placebo-controlled, open-label study

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